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Proper communication between the entire interprofessional healthcare team, including nursing staff, anesthesiologists, and surgeons, is vital in preventing injury during hand positioning. Understanding the nature of the injury and constant surveillance of the patient can minimize the perioperative incidence of nerve injury. The ulnar nerve is commonly injured in prolonged surgery. Efforts should be made to minimize the pressure on the ulnar nerve by tucking the patient's arms by their side in a thumbs-up position. If abduction or flexion is needed, it should be less than 90 degrees. In laparoscopic surgeries where steep positioning is needed, patients on the bean bag with shoulder braces have shown significantly less displacement compared to the memory foam pad.[9][Level 2] Therefore, a bean bag and braces should be used in a Trendelenburg position to avoid cephalad shift and downward force on the shoulder. This can contribute to lowering the risk of injury to the upper brachial plexus.[2][1][3] If head rotation is necessary, such as in carotid endarterectomy, contralateral arm abduction should be avoided due to the risk of injury to the brachial plexus. Arms could be tucked at the patient's side to avoid any excess traction. Overall, proper communication and frequent positioning checks could help reduce the incidence of injuries perioperatively.[6][10]